Wednesday, December 17, 2014

Dementia: An Early Experience.

It's been a very long time since my last post! I graduated from school last May, and life has kept me busy! Throughout the year, I had many different ideas on what to write about, but I haven't posted any of them (obviously). Nonetheless, writing and sharing are always on my mind, and lately I've been thinking about my early encounter with dementia as I witnessed my father's dramatic behavior changes. Here is my experience:

At the Beach: Father posed for the camera as I collected seashells.
Between 2005 through 2010, I was a caregiver for my late father who had multiple chronic health conditions. To complicate matters, my father was developing dementia, but I did not realize this. I had no knowledge of what dementia was, and could not understand why my father’s personality had changed so dramatically. Even though my mother lived with him, she was also struggling with her own health challenges. With each visit, I was beginning to notice changes in my parents’ living environment such as overdue billing statements, unused medications, burned pots and pans, and unlocked doors. These changes were worrisome and often kept me up at night. Thus I decided to step in and help my parents. The following paragraph describes my early experience in witnessing my father’s behavior, which I now recognize were symptoms of dementia.

In 2005, my father started to exhibit behavior that was very strange. When he wanted to go to sleep, he would ask my mother to help him. (He had multiple strokes over the course of 10+ years, so he needed assistance with getting into bed at night.) My mother would proceed to tuck him in, and go back to the family room to watch television. A few minutes later, my father would come back and ask my mother to help him to bed. She would repeat the same process, and then moments later, he would come back again to ask for help into bed. He would continue with this behavior repeatedly. It would continue for at least 2-3 hours, every single night! My mother, in frustration, would ask him why he keeps coming back to the family room only to ask to be put to bed again. In response, my father would just look at her with a slight grin on his face and say nothing. Then, he would continue the back-and-forth routine. Although irritated, my mother did not question why my father behaved this way. She simply thought it was another one of her husband’s quirks. When I observed this situation, I thought that there was something seriously wrong, but I couldn’t understand what it might be. My father’s behavior was so out of character that it made me feel uncomfortable. This situation lasted for several months, and it stopped when my father had another stroke. New behaviors (i.e., making inappropriate comments, having emotional outbursts), however, were beginning to emerge.

I have many old notes on my experiences as I struggled to help care for my father. I hope to share them now and again, and perhaps it could help spark meaningful conversations. I would love to hear from you about your thoughts and experiences. Thanks for visiting my blog! Have a wonderful, healthy holiday season! 

Monday, April 28, 2014

Exploring the Potential of Assistive Robots.

Frank: Can't you do that super fast?  Robot: Some things take time, Frank. -- Robot & Frank, 2012.

As you know, I've been researching and writing a paper on the topic of assistive robots for older adults living in their homes. The topic caught my interest as I pondered the caregiver shortage and possible solutions.  Well, I'm nearly finished with my paper and presented a poster on this topic last week. 

I learned so much from this process and here are some interesting findings:

  • Older adults are open to the idea of robots performing practical tasks such as managing information, manipulating objects, and assisting with household chores. Most prefer human aid for personal care needs (Smarr et al., 2013)
  • Many expressed preferences for small, creative looking robots with combinations of human-like and machine-like traits. Humanoid robots were the least favored (Wu, Fassert, & Rigaud, 2012).
  • For older adults, robots must fit seamlessly into living environments because home is a central, interconnected hub where people, products, and activities come together (Forlizzi, diSalvo, & Gemperle, 2004).
  • Very few studies have considered socio-demographic variables on studies of robot acceptance and usage (Flandorfer, 2012).

Presenting my poster at a graduate studies showcase. (Photo on right: by D. Houlton)
Despite fear and hesitancy towards the idea of assistive robots, those who participated in user studies had mostly positive experiences, and many suggested that they would not mind having such devices in their homes. In a few studies, however, older adults stated that robot usage represents loneliness, frailty, and isolation. Thus they would not utilize robots. 

Presently, there are ethical concerns, cost of robots, and lack of availability. These are all important issues to consider. Furthermore, there is a general lack of user studies with older adults.  I believe that robots have potential to provide assistance, but I also believe that there are so many areas that need to be addressed in order to move forward.  On a positive note, there are many new technological products being created for older adults to live safely and independently in their homes.

Thank you for visiting my blog. If you have questions or comments, I would be interested in hearing from you. Less than one month until graduation! Woohoo!!!

Sunday, March 9, 2014

Robots and Older Adults: Prevalence of Ageism.

"Age is an issue of mind over matter. If you don't mind, it doesn't matter." -- Mark Twain

Time flies when there's so much to do, and it's been awhile since my last post! I have been researching articles for my paper, and slogging away through the initial draft process. It's been a challenging experience, but I've been learning so much!

Although there are many articles in the area of assistive robots, they are either focused on technical aspects, or emphasize views of designers, technologists, and other parties who are not the intended end-users. I'm not suggesting that their views are unimportant, yet I think it's perplexing that the most relevant persons, namely older adults, have played only a minor part in the conceptualization and testing of products. Then, I read a few mind-opening articles: one written by Peine, Rollwagen, and Neven (2014), and the 
other written by Neven (2010).

Me, as a chubby-cheeked 3-year old, posing with relatives.
Peine et al. wrote about how stereotypical assumptions of older adults leads researchers and designers to create products that lack meaningfulness, thereby overpowering older adults' potential to be co-producers in creating innovative products. Moreover, Peine et al. call critical attention to the paternalistic view in gerontechnology where older adults are expected to be the passive recipients of products. 

Likewise, Neven found that older participants in robot user-studies saw themselves as test usersrather than old people that such products were designed for. Many in Neven's study viewed themselves as healthy and active, thus they felt they were assisting research to help others who were weak and socially isolated. The authors in both articles point to the negative ways of how assistive products are positioned -- as aides for older persons who need help due to age-related declines, rather than as useful devices for individuals who wish to enhance their independence.

These articles really made me think. If I were the intended recipient of such products, I would be offended by the ageist views that are assumed as fact concerning older persons, such as being tech-averse, ignorant, or slow and decrepit. It makes me understand one reason (out of many) for the discrepancy between the availability of robotics products and the lack of older users. There's still more I can say about this issue, but I have to get back to writing my draft! Thank you, as always, for visiting. I hope to post again within a few weeks, but please feel free to comment.

Sunday, February 9, 2014

Robots as Caregivers: Is it Unethical?

“Our very lives depend on the ethics of strangers, and most of us are always strangers to other people.” -- Bill Moyers

As I had mentioned in an earlier post, I am exploring the idea of robots as caregivers for older adults and will be writing a literature review as part of my graduate thesis project. I became intrigued by the idea of assistive robots as I pondered the caregiver shortage coinciding with the growing numbers of older adults. Although I don’t think of myself as pro-robot, I don’t believe that the use of robots is completely unethical.

There are arguments suggesting that the use of assistive robots will further marginalize older adults who are disregarded by society. Some declare that robots cannot understand human emotions, and therefore cannot provide the sensitive touch of human caregivers. Others argue that reliance on robots would increase social isolation. These concerns are very important, but the reality is that there is a shortage of caregivers. Robot technology may be one option that can help fill in some of (though not all) the gaps. Robots may even provide respite and assistance to formal and informal caregivers because let’s face it –- caregiving is hard work!

At age 3: Trying to be a lady.
Undoubtedly, social isolation is common among older adults, particularly those with cognitive and physical challenges. I’ve even witnessed it among some older clients I work with. However, social isolation is not a new phenomena, and it has existed prior to technological advancements. Alternatively, it may be possible that robots can help enhance social interactions and connections with family and friends.

Furthermore, if we are truly concerned about social isolation, all of us can make efforts to support older persons. It’s easy to criticize the use of robots, but are we all willing to take steps (big and small) to reduce or eliminate the need for such devices? Are we willing to pay more to ensure fair compensation for caregivers?

Many loose ends exist at this point, and I’ve only begun my research. Personally, some of my issues regarding robots include cost and availability. As I’ve been combing through the literature, presently it seems that care robots are expensive and unavailable to the masses. But for now, I will conclude with one final thought -- perhaps asking older adults about their views and wishes on this subject matter would be an ethical consideration. Thank you for reading my post, and please share your thoughts and comments!

Sunday, January 26, 2014

A Sense of Purpose.

"You are never too old to set another goal or to dream a new dream." -- C.S. Lewis

Recently, I saw the movie Nebraska, in which an older gentleman named Woody Grant receives a sweepstakes letter suggesting he might be a million dollar winner. Woody's family warns him that this is a scam; nevertheless, Woody determines to do whatever it takes to get to Nebraska to claim his prize (even if this means walking all the way from Montana).
Father, mother, brother & cousin.
Woody’s indomitable spirit made me think about the concept of ikigai, a Japanese word that roughly translates as something to live for, or reason for being. For Woody, whose aged body and mind reveal the long-term effects of alcohol abuse, getting to Nebraska wasn’t just about the prize. Rather, it was about striving towards a significant, larger-than-life goal. Getting to Nebraska represents Woody's ikigai.
Ikigai is integral to life satisfaction no matter what age you may be. Even so, it is more challenging for older persons when goals are besieged by a myriad of obstacles such as health issues, loss of loved ones, and financial difficulties. My own immigrant parents have had many dreams, and also experienced great disappointments due to illness, loss of income, and family discord. Despite hardships, my parents courageously pushed themselves to get up everyday and to move forward. 
My Buddhist mentor Daisaku Ikeda, who turned 86 this past January, states, “This lifetime will never come again…to live without regret, it is crucial for us to have a concrete purpose and continually set goals and challenges for ourselves…” Are we ever too old for dreams? For me, the answer is no, but I would be interested in hearing your thoughts and comments. Thank you for taking the time to visit my blog.

Wednesday, January 15, 2014

When life gives you lemons...

"...You may be given a load of sour lemons, why not try to make a dozen lemon meringue pies?" -- Maya Angelou

The other day, a neighbor gave us lemons from her lemon tree. It was perfect timing because I had intended to make lemon bars to honor the 4-year anniversary of my father's passing on January 15 (which is today). Why lemon bars? Well, lemon pie was my father's favorite dessert, and occasionally, I would bring this treat when I visited father in the nursing home. When lemon pie wasn't available at the bakery, I would bake lemon bars to substitute. Luckily my father did not seem to mind, and I can still visualize the the joy on his face as he enjoyed his lemony delight. With the progression of dementia, father's vocabulary became limited. Interestingly, lemon pie was one of the few phrases he never forgot, and he often reminded me to bring his favorite treat on my next visit. As time went on, I brought lemon bars more often than pies because it was simple to make, but nonetheless delicious. Father's favorite part was the tart, lemony filling.

My father, mother and me next to the lemon bar (made with love).
My paternal grandfather was an actor who provided for his large family through operating a neighborhood bakery. Not surprisingly, my father grew up eating sweets and continued to enjoy them throughout his life. My grandfather's bakery in Japan did not have lemon pies, so it seems father discovered them when we moved to the U.S. I never asked him why he loved lemon pies over every other sweet, but it is one of the details about my father that always makes me smile. The well-known adage suggests, "when life give you lemons, make lemonade." In my case, I make lemon bars. In doing so, January 15th feels more bearable as I reminisce about the many happy moments I shared with my wonderful father.